california state innovation model testing grant proposal ... · center for medicare and medicaid...
TRANSCRIPT
California State Innovation Model
Testing Grant Proposal
Accountable Communities for
Health Initiative
Stakeholder Webinar
Friday, September 26th
10:00-11:00am PT
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Welcome and Agenda for the Webinar
1. Status Update of California’s Proposal to CMMI State
Innovation Model (SIM) Testing Grant
2. Overview of Accountable Communities for Health
Initiative Design Process
3. Key elements of proposed Accountable Communities
for Health
4. Feedback and Input
2
Center for Medicare and Medicaid
Innovation State Design and Testing Grant• California received a SIM Design grant in March 2013.
• Design grant produced the California Health Care
Innovation Plan, finalized March 2014.
• California’s proposal for a $99.7 million SIM Testing grant
was based on the Innovation Plan, submitted on July 18,
2014.
• Up to 12 State Innovation Model (SIM) Testing Grants from
$20 million to $100 million will be awarded.
• Grants will last four years, including a year of planning.
• Estimated period: January 2015 – January 2019
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Stakeholder Engagement
• Cal-SIM Design grant work group leaders and participants
from private sector with state liaisons
• Stakeholder meetings held along way – in person and
webinars
• Approximately 90 letters of support received for Testing
grant proposal
• CHHS.ca.gov web site provides regular updates
• Comments can be sent to [email protected]
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Highlights of State of California’s Proposal
Grant and Overall Innovation Plan Management
5%
Maternity Care 15%
Health Homes for Complex Patients
20%
Palliative Care5%
Accountable Communities for
Health9%
Workforce3%
HIT/HIE9%
Enabling Authorities0%
Cost and Quality Transparency Database
20%
Public Reporting2%
Payment Reform Innovation Incubator
4%Other8%
Cal SIM Testing Grant Draft Budget
• To provide information about
the potential opportunity to
stakeholders
• To obtain feedback and input
in the design process
• To solicit information from
communities about current
activities
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Accountable Communities for Health (ACH)
Overview
Vision and Goals of ACH
• Three pilots of a new population health model to provide
proof of concept
• Collaborative model that links health care systems with
community resources and which maintains a focus on
prevention
• Portfolio of interventions that span clinical and
community settings
• Local Wellness Fund as a vehicle for pooling resources
to sustain the ACH and reinvest in community-wide
interventions to address goals identified by the ACH
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Accountable Communities for Health (ACH)
Overview
Current Workgroup Process
• Workgroup began meeting in November 2013
• Stakeholders from health plans, hospitals,
clinics, county health systems, public health,
prevention, academia, and philanthropy
• Notes posted
http://www.chhs.ca.gov/pages/pritab.aspx
• Final report of workgroup due date Dec 2014
• The California Endowment is providing critical
support 10
Accountable Communities for Health (ACH)
Overview
State Implementation Process/Timeline
2015
• Jan-March: Vet and finalize RFP
• April-Sept: Release RFP, host webinar, review
proposals, and select pilots
• Mar-Sept: Develop TA and training plan for ACH pilot
sites
• Sept-Dec: Pilots refine and finalize plans, budget and
goals
2016 – 2018: Pilots implement ACHs
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Accountable Communities for Health (ACH)
Overview
Working Definition:
An Accountable Community for Health is a collaborative
of the major health care systems, providers, and health
plans, along with public health, key community and
social services organizations, schools and other
partners serving a particular geographic area. An ACH
is responsible for improving the health of the entire
community, with particular attention to reducing health
disparities.
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What is an Accountable Community
for Health (ACH)?
Working Definition (cont.):
The goals of an ACH are to 1) improve community-wide
health outcomes and reduce disparities with regard to
particular chronic diseases; 2) reduce costs; and, 3)
through a Wellness Fund, develop financing mechanisms
to sustain the ACH and provide ongoing investments in
prevention and other system-wide efforts to improve
population health.
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What is an Accountable Community for Health
(ACH)?
Draft Criteria: With only 3 pilots, the criteria are
designed to set a high bar of readiness. Draft criteria
address:
1. Collaboration/Partnership
2. Structure/Process
3. Leadership and Support
4. Geography/Geographic reach
5. Program
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ACH Proposed Design Elements
1. Collaboration/Partnership
• An existing coalition of health care providers, public
health, and social and community organizations
• A history of successful collaboration among key
institutions with evidence of shared goals and mutual
respect
• Experience in implementing community/environmental
change strategies
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ACH Proposed Design Elements
2. Structure/Process
• HIT/HIE and ability to share data
• Identification of a “backbone” organization
• Identification and agreement about the location and
structure of the Wellness Trust
• Agreed-upon community health needs assessment
• Presence of some form of integrated care, including health
homes, PCMH, ACOs, etc.
• Agreed upon goals relating to the Triple Aim
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ACH Proposed Design Elements
• Key roles of a “Backbone/Integrator”
Guiding development of a common
vision, goals and strategy
Facilitating development of agreements
across collaborative partners
Coordinating and supporting
implementation of aligned activities
Identifying data needs, establishing shared
measurement practices and facilitating data sharing mechanisms
Managing the budget
Building support
Facilitating data collection and evaluation
Mobilizing funding through the Wellness Fund
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ACH Proposed Design Elements
3. Leadership and Support
• Strong champion(s) with demonstrative ability for
collaborative leadership
• Active engagement support from majority of health plans
and health systems, public health department, and
diverse communities, organizations, and agencies within
the identified geography
• Strong support from local political leaders, government
officials, and other civic leaders
• Commitment of resources
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ACH Proposed Design Elements
4. Geography/Geographic reach
• Defined geography, with a goal of reaching the majority of
the population
Large enough to have a measurable impact and demonstrate an
ROI, but small enough for the ACH members to develop
meaningful partnerships
• Demonstrated health disparities with regard to overall
chronic disease burden and the target condition
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ACH Proposed Design Elements
• ACHs will select a condition to target, likely either
diabetes, cardiovascular disease or asthma
• Implement a “portfolio of interventions” across five
domains, which collectively advance health outcome and
financial goals:
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What will an ACH do?
Policy and systems
Environments
Community resource and social services
Community-Clinical Linkages
Clinical Services
Intervention/Pr
ogram
Time
Frame (e.g. short,
med, long)
Complementary
intervention
Outcome
Metrics
Clinical services
Community
programs &
resources
Clinical-
Community
Linkages
Public Policy &
Systems
Changes
Environmental
Changes
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ACH Portfolio of Interventions
Literature Review of Evidence
• Setting for the intervention
• Strength of evidence
• Ease of implementation
• Time
• Cost
• Complementary and potential synergistic impacts
Steve Shortell, PhD MPH MBA, Center for Healthcare Organizational
and Innovation Research, UC Berkeley School of Public Health
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ACH Portfolio of Interventions
Wellness Fund
• Vehicle for sustainability
• Pooling of resources
• Public
• Private
• Health care savings
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How will an ACH be financed and become
sustainable?
Outcomes and Metrics: Short-Medium-Long term
1. Outcomes
• Health care cost avoidance/ROI
• Care coordination
• Health behaviors
• Community conditions
• Community & population health outcomes
• Health equity
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How will success be determined?
2. Structure and Process
• Partnerships
• Data sharing
• Governance
• Accountability system
3. Financing
• Wellness Fund & sustainability plan
• Payment reform
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How will success be determined?
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Comm-
unity
clinic
Comm.
& Soc
Services
Hospital
Wellness
Fund
Portfolio of interventionsClinical Community-Clinical Community Resources Policy & Systems Environmental
Services Linkages & Social Supports Changes Changes
Braiding existing
funding &
programs for
interventions
Backbone/Int
egrator
organization
CBOs
& Faith
Comm.
SIM
Grant
Funds
Public
&
Private
Funds
Employ-
ers/busin
ess
Community Collaborative and Governance
Improved Health Outcomes Short term Medium term Long term
Payment
reforms
Capture
savings
and
reinvest
Identify savings
across providers,
systems &
sectors
Resi-
dents
Schools Health
planConsumer
& advo-
cacy orgs
Public
health
dept
County
Health/
Govt.
agencies
Accountable Community for Health: Proposed Structure and Outcomes
1. Technical Assistance, such as financial modeling
2. Learning Community
3. Evaluation
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What Supports Will Likely Be Provided?
• Identify what types of activities are underway to help
inform the further development and design of the ACH
• This request is not related to the future application
process.
• Please complete the Form by COB, October 10, 2014
• http://tinyurl.com/nnxezby
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Reminder: Information Gathering Form